Wednesday, July 04, 2007

Oh. There you are.

Hello everybody! Sorry about the, uh, total lack of communication on my part here. I can't even claim that residency has sucked away all my free time..I mean, it's sucked away the vast majority of my free time, but I've just been a smidge lazy lately on my down time.

So...where were we? Ah yes! I had moved to STL for residency, my computer croaked, and I was in the midst of a minor myocardial infarction myself. An incredible person saved my computer for $80, and I lost all my iTunes but that was a totally acceptable alternative to losing EVERYTHING, because then someone might have had to die.

I started residency, and am currently on benign surgery. I get in around 5:30 and usually leave around 6:30. It's really not bad right now, with the exception of weekend call which I basically have every weekend this block - either 24 hours on Saturday or Friday night/Sunday day. Currently, though, I'm on vacation. Yes. That's correct. I worked for 3 weeks and then I was awarded one of the precious THREE vacation weeks I get all year. It's ok though, to be honest I could use a breather right now, and I'm happy that it's warm enough that I can actually do enjoyable things with my time visit a certain very charming aerospace engineer (VCAE) I met at a wedding a few weeks ago. (Ok...if you really want all the painful details I met him when I interviewed at a program in California back in November, and we just happened to see each other again at this wedding.)

I like surgery. I like this rotation. I get to operate all day and then just come home. Our patients are rarely seriously ill and have few post-operative complications. The only bad part about being the benign intern is that we have to do circumcisions. Which I hate hate HATE doing. I'm not passing opinion on the circs themselves, but I think it's dumb that ob/gyns got stuck doing them. We practice medicine and operate on the reproductive tracts of adult women. How the hell did I get stuck slicing the foreskin of newborn baby boy penii?

First, I have to go consent the mother. I always take great pains to explain that this is an ELECTIVE procedure, meaning NOT MEDICALLY NECESSARY, and we are only doing it ELECTIVELY. I also explain the usual risks of infection, bleeding, blah blah complication-cakes, but the most important risk is the risk that what looks like a good circumcision to me may not look like a good circumcision to them. Though, for most of the circs I've done, I think we can all agree that I haven't produced some good-looking penii. NOTE: This is a cosmetic issue only. I know what I'm doing enough to take the foreskin off in a clean and safe manner with no harm to the head of the penis. These babies will urinate and have babies of their own in the future, but they won't have the most attractive penis in the world. Sometimes I'm just a little uneven in the actual amount of foreskin I remove from the front and back. There's a lot of that stuff to go around, and it's awfully wrinkly and bunchy.

The best part about consenting patients (or in this case their moms) is that occasionally one will say no and just flat-out refuse the procedure. In this case, where it's an elective procedure that I hate doing, I am completely okay with this. In fact, I've considered carrying around the actual restraint gear we STRAP the baby to.
I think being strapped down is the most upsetting part for the babies.

As far as actual procedural devices, I'm a Gomco girl myself.

It takes a little longer and requires some more coordination than the Mogen, but I like that the little bell protectively sits over the head of the penis, thus ensuring that no goofage and injury to the penis head will occur. I offered to bring both devices to VCAE and give him a demonstration but he politely demurred.


Anonymous said...

I've also thought it odd that those who specialize in female parts are tasked with male circumcisions.

I've got a few questions if you have a moment.

1) Is a thorough description of Sorrells results, released earlier this year, now a common component of consenting the mother?

2) Are you free to exercise your understanding of proper medical ethics (as recommended by DOC) by declining to offer or perform non-therapeutic circumcisions, without putting your job at risk?

3) Is it common for this procedure to be offered even when the parents don't ask about it?

Thanks for any insights you can share. I have some concerns about this procedure, since it's elective surgery on an infant.

gabbiana said...

YAY! I'm glad you posted. And that you're surviving residency and having fun, too. Who is this boy? Story story story!

(I like to live vicariously. Sorry about that.)

Circumcisions! My friends warned me about the little strap-down baby... thingies. Apparently there is a whole counter-ful of them sometimes? And you just go from baby to baby?

(Thanks also for those links, because: Hee, penises are always funny.)

Anyway. I am glad you are not dead, I am glad your computer is not dead, I am glad that working 13-hour days is not sucking the life force out of you. Keep posting when you can, and, uh, I hope you escape the wee bitty penis duty soon.

TLC Tugger said...

Thanks for posting.

See the story of Marilyn Milos; you have the right to decline to do harmful procedures. No medical association on earth recommends infant circumcison. Most roundly condemn it. Make some history.

Yes, the strapping down may be the most traumatic part of the infant circ procedure when anesthetic is used, but growing up and knowing that valuable sexual parts that 80% of the world enjoys are missing from your body can be pretty traumatic, too (even assuming the patient is lucky enough to avoid the many side-effects that are recovery related and outside the surgeon's control).

Just say no to cosmetic alteration of infants' genitals.

HIS body HIS decision

Rahul said...

Circumcisions always remind me of Robin Head, um, Hood (I guess that's good too), Men in Tights, where Mel Brooks plays a rabbi (the Friar Tuck equivalent). I see you followed his suggestion about age groups.

Rabbi Tuckman: A moyel is a very important guy. He makes circumcisions.
Scarlet: What, pray tell, sir, is a circumcision?
Rabbi Tuckman: It's the latest craze. The ladies love it!
Little John: I'll take one!
Achoo: Hey, put me down for two!
Robin Hood: I'm game. How's it done?
Rabbi Tuckman: It's a snap.
[demonstrates with a carrot and a miniature guillotine]
Rabbi Tuckman: I take my machine here, I take your little thing, I put it through this hole, and then...
[releases the blade, cutting the end off the carrot]
Rabbi Tuckman: I nip the tip! Whose first?
Merry Men: [groan]
Rabbi Tuckman: I gotta start working with a younger crowd.

Also, if you ever want to ramp up the bris business, you can try his tack of advertising circumcisions "half off". People will skin themselves trying to get there 'fore the others!

B Maurene White said...

Haven't you heard of 'doing no harm'? or the right to choice by the patient himself, not third parties? or the benefits of the prepuce Taylor '96, '99, Sorrels '07 all Brt Jnl Of Urology)? or had sex with a normal intact man?, or heard of William Stowell (and now several others) who have sued their circumcisers for huge amounts of $$$ and won?

Imagine yourself 18 yrs from now, nicely into some sort of hopefully non-circumcising practice, and along comes one of those babies who didn't like being strapped down and sliced, and there goes $500,000 off your investment portfolio. With the amount of thought and compassion you've put into mutilating other human beings' sexuality, that's just what you will deserve.

For a few more pointed questions:

B. Maurene White R.N. Founder, Chair, Director

Rose Connors said...

Down on circs! I found you by searching "night shift slobs" and happily added you to my bloglines. I'm a med-surg RN in rural Oregon.

Anonymous said...

Eagerly awaiting your next post.

Anonymous said... B. Maurene white...I know as a nurse, you probably have little clue how medical training i.e. RESIDENCY works. You do what you are told to do by your superiors, and it is usually in the interest of learning. Regarding your "getting what she deserves" comment - you're obviously an idiot. IT IS THE PARENTS WHO DETERMINE IF THEY GET THIS PROCEDURE! It is not up to the medical providers to determine who gets these, it is the parents. Certain religions demand that this occurs as well, and it's totally up to them.

Monkey McWearingChaps said...

While your musings on school and desi boys are awesome (they mirror many of my own complaints), you MUST keep commenting on these hotbutton medical issues. I love how you draw all the nutters out of the woodwork when you post about them. Please please please post on vaccinations-do you know there are psychos out there who are anti-vax based on a thoroughly debunked study?

working said...

Maybe you guys don't understand - she's an intern, she doesn't even get to pick when to go to the bathroom, so she might not want to refuse to do circs right off the bat ;). When she's an attending, she doesn't have to do them.

Social Justice said...

Doctor and Hospital Settle Circumcision Lawsuit

Stage Set for Men to Sue for Being Circumcised as Infants

SUFFOLK COUNTY, New York – After a two-and-a-half year legal battle with Plaintiff William G. Stowell, the doctor and hospital have settled the landmark circumcision case brought against them. The terms of the settlements have not been publicly disclosed. Twenty-one-year old Stowell filed suit December 19, 2000, in the U. S. District Court for the Eastern District of New York, against the hospital where he was circumcised and the physician who circumcised him as a newborn.

Stowell, born on December 22, 1981, in West Islip, NY, was circumcised the following day by his mother’s obstetrician. This case presented the issue of the legal validity of consent for circumcision obtained by a nurse from a mother who was debilitated by the effects of a Caesarian section and painkillers. It also questioned whether a physician could legally and ethically remove healthy, normal tissue from a non-consenting minor for non-therapeutic reasons.

David J. Llewellyn, one of Plaintiff Stowell’s attorneys, said, "William and I are very happy that we were able to resolve this case with both the hospital and the doctor. While a settlement is never an admission of liability, I believe it shows that our allegations were taken seriously. Never again can someone say that a young man who is dissatisfied with his circumcision as an infant is being frivolous when he objects to his mutilation and brings suit to obtain justice. This case should send a message to doctors that they run the risk of a lawsuit each time they circumcise an infant for non-therapeutic reasons, particularly when they rely on the hospital to obtain consent the day after birth. Social or cosmetic concerns provide no justification for harmful surgery. I would expect that this is just the first of many cases that will be brought by angry circumcised young men against their circumcisers."

The American Academy of Pediatrics (AAP) first acknowledged that there was no medical justification for routine circumcision in 1971. Last year, the AAP reaffirmed that it does not recommend routine circumcision. The American Medical Association concurred this year, calling routine circumcision "non-therapeutic." No national or international medical organization recommends routine circumcision.

The case has received national attention from Good Morning America, Newsweek, The New York Post, and other prominent media sources.

Anonymous said...

there is a special place in hell for doctors like you who perform this barbaric procedure on children. The patient is the CHILD, not the mother. You have no right to mutilate the genitals of boys. Fuck you.

Anonymous said...

You think you are so smart being a medical intern. You don't even know the anatomy/physiology of the foreskin and obviously have never had sex with a normal penis. btw, how much do you sell the foreskins for? $200 each? How much? You will be in jail some day for this mutilation.

Anonymous said...

Just wanted to share this with you...


Irene said...

There's no doubt, the dude is absolutely just.